Pancreatic diseases are often accompanied by pleuropulmonal complications. Acute pancreatitis may induce a number of various pathological findings in respiratory tract including hypoxemia, decrease of transfer-factor (DLCO), decrease of transfer-coefficient (DLCO/VO), decrease in forced expiratory flow 25%- 75% of forced vital capacity (FEF25-75%), elevated and/or immobile diaphragm, basal atelectasis, unilateral or bilateral pulmonary infiltrations, mediastinal pseudocyst and pleural effusion. Acute respiratory distress syndrome (ARDS) is the most dangerous complication of acute pancreatitis. Large, recurrent pleural effusion is sometimes present in chronic pancreatitis, typically with a very high concentration of amylase in pleural fluid. Pancreaticopleural fistula (PPF) is the most common cause of this type of pleural effusion. We describe a study group of 3 patients with PPF and pleural effusion, their clinical symptoms, diagnostics and management.